Parenteral nutrition process (from medical prescription to nurse administration) without (re) transcription

Introduction
The neonatal intensive care unit of our hospital takes care of extremely premature infants (< 1000 g). These small patients require the use of parenteral nutrition for several weeks for growth and development. Our pharmacy department is in charge of the parenteral nutrition admixture preparation since 2017. We have gradually improved the process from prescription to administration according to IGAS recommendations (2015) which recommend an integrated system for all steps from prescription to administration (including automated compounding). They also recommend an integrated prescription software for medication and nutrition.

Materials and Method
We have gradually purchased the following support systems:
* 2017: BPprep (Alma): compounding pharmacy software
* End of 2017: Medimix (IMF): automated compounding device
* 2018: Logipren V2: neonatal prescription software (for medication and nutrition)

With the software editors we have developed:
* 2017: interface between BPprep (compounding software) and MediMix (automated compounding device)
* 2018: interface between MediMix and BPprep (weigh data)
* 2019: interface between Logipren (prescription software) and BPprep

Results
Doctors prescribe the parenteral nutrition and medications in Logipren. Pharmaceutical prescription verification in Logipren generates the transmission of all data useful to preparation to BPprep. The pharmacist uses BPprep to input the compounding order to the automated compounding device (ACD) and to generate the different documents (labels, compounding indications, control indications). The ACD starts the production of the preparation by reading the barcodes on the preparation labels. The preparation is weighed in order to be approved. The ACD sends the weight data to BPprep for traceability and control. The other quality controls are manually completed in Bpprep. The preparation is then released and dispensed with BPprep. The nurses monitor/trace the administration in Logipren.

Discussion
The advantage of this process is to avoid all retranscriptions of data between the prescription, the pharmaceutical verification and the production and to have an electronic traceability of all steps.

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